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Objectives: With the increase in life expectancy and the aging of the population, chronic kidney disease has become increasingly prevalent in our environment. Kidney transplantation remains the gold standard treatment for end-stage renal disease, but the supply of renal grafts has not been able to keep pace with growing demand. Because of this rationale, organ selection criteria have been extended (expanded criteria donation), and alternative donation types, such as donation after circulatory death, have been evaluated. These approaches aim to increase the pool of potential donors, albeit with organs of potentially lower quality. Various forms of donations, including donation after circulatory death, have also undergone assessment. This approach aims to augment the pool of potential donors, notwithstanding the compromised quality of organs associated with such methods. Diverse strategies have been explored to enhance graft function, with one of the most promising being the utilization of pulsatile machine perfusion., Materials and Methods: We conducted a retrospective analysis on 28 transplant recipients who met the inclusion criterion of sharing the same donor, wherein one organ was preserved by cold storage and the other by pulsatile machine perfusion. We performed statistical analysis on posttransplant recovery parameters throughout the patients' hospitalization, including admission and discharge phases., Results: Statistically significant differences were noted in delayed graft function (P = .04), blood transfusions requirements, and Clavien-Dindo complications. Furthermore, an overall trend of improvement in discharge parameters and hospital stay was in favor of the pulsatile machine perfusion group., Conclusions: The use of pulsatile machine perfusion as a method of renal preservation results in graft optimization, leading to earlier recovery and fewer complications compared with cold storage in the context of donation after circulatory death.

Objectives: To evaluate the outcomes of robot-assisted radical prostatectomy (RARP) compared to those of open (ORP) and laparoscopic (LRP) surgery. The interest lies fundamentally in the quality-of-life (QoL) evaluation, postoperative recovery, and personal satisfaction of patients with the intervention (PS) beyond oncological and functional outcomes., Methods: Six hundred eighty-five RPs were performed in our center between 2011-2018 (17,8% ORP, 22,2% LRP and 60% RARP). Patients were prospectively assessed through follow-up until April 2020 and a multiple questionnaire at 12-months post-RP that included ICIQ-SF, SHIM, IPSS, IQL and questions about pain, postoperative recovery and PS. Also baseline and postoperative patient- and treatment-related data were collected, and binomial logistic regressions were performed for the 1 vs.1 comparisons (ORP vs. RARP and LRP vs. RARP)., Results: RARP patients have overall fewer comorbidities, less tumor aggressiveness, more operative time requirements and more positive surgical margins than ORP and LRP patients. Nevertheless, RARP outperforms ORP in: hospital stay (days) (OR 0,86; 95% CI: 0,80-0,94), hemoglobin loss (OR 0,38; 95% CI: 0,30-0,47), transfusion rate (OR 0,18; 95% CI: 0,09-0,34), early complications (p = 0,001), IQL (OR 0,82; 95% CI: 0,69-0,98), erectile function (OR 0,41; 95% CI: 0,21-0,79), pain control (OR 0,82; 95% CI: 0,75-0,89), postoperative recovery (p < 0,001) and choice of a different approach (OR 5,55; 95% CI: 3,14-9,80). RARP is superior to LRP in: urinary continence (OR 0,55; 95% CI: 0,37-0,82), IPSS (OR 0,96; 95% CI: 0,93-0,98), IQL (OR 0,76; 95% CI: 0,66-0,88), erectile function (OR 0,52; 95% CI: 0,29-0,93), postoperative recovery (p = 0,02 and 0,004), PS (p = 0,005; 0,002; and 0,03) and choice of a different approach (OR 7,79; 95% CI: 4,63-13,13)., Conclusions: The findings of our study globally endorse a positive effectiveness of RARP over ORP and/or LRP, both on functional issues, postoperative recovery, QoL and PS. Oncologic results should still be improved., (Copyright © 2021. Published by Elsevier España, S.L.U.)

Aims: To identify the definition for urinary continence (UC) after radical prostatectomy (RP) which reflects best patients' perception of quality of life (QoL)., Methods: Continence was prospectively assessed in 634 patients, 12 months after RP using the International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF) and the number of pads employed in a 24-hour period (pad usage). We used the one-way ANOVA technique with posthoc pairwise comparisons according to Scheffé's method (homogeneous subsets) for assessing the degree of QoL deficit related to urinary incontinence (UI)., Results: The continence prevalence is 64.4%, 74.1%, 88.3%, and 35.8% using "0 pads," "1 safety pad," "1 pad," and "ICIQ score 0" definitions, respectively. Pad usage is moderately strongly associated with ICIQ 1, 2, and 3 (ρ = 0.744, 0.677, and 0.711, respectively; p < 0.001). Concordance between classical UC definitions is acceptable between "0 pads-ICIQ score 0" (K = 0.466), but poor for "1 safety pad" and "1 pad" (K = 0.326 and 0.137, respectively). Patients with "0 pad usage" have better QoL related to urine leakage than patients with "1 safety pad" or "1 pad" (1.41 vs. 2.44 and 3.11, respectively; p < 0.05). There were no significant differences found regarding QoL between patients with ICIQ score 0 and ICIQ score 2 (1.01 vs. 1.63; p = 0.63)., Conclusions: Pad usage and the ICIQ-SF's answers provide useful information. We propose a combined definition (0 pads and ICIQ score ≤2) as it is the definition with the least impact on daily QoL., (© 2021 Wiley Periodicals LLC.)

Introduction: With the advanced laparoscopic and robotic surgery, thromboembolic prophylaxis in urologic procedures has traditionally been based on the experience of other surgical specialties. This paper aims to analyze the current recommendations, through a detailed study of the European clinical guidelines and bibliography, applying the recommendations of thromboprophylaxis to the daily urological practice., Objectives: To elaborate general recommendations to surgical patients in Urology, avoiding the risk of perioperative thromboembolic events. Optimize medication in chronic patients and accurately classify who are eligible for bridge therapy., Material and Methods: A review of the available literature and the European clinical guidelines was carried out. We analyzed the most recent consensus articles by studying the available bibliography, trials and reviews on which the European guidelines for thromboprophylaxis in urology are based., Results: Thromboembolic prophylaxis should be targeted towards surgeries that require abdominal approaches, prolonged bed rest or oncological pathologies. Bridge therapies with low molecular weight heparins should be limited. Patients undergoing treatment for chronic conditions can benefit from bridge therapies in specific cases., Conclusions: According to the current guidelines, there might be an overuse of heparins in the daily clinical practice. The development of -direct oral- anticoagulants have shown to reduce the time to reintroduction of medication for chronic conditions as well as a more effective bleeding management., (Copyright © 2019 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Prostate cancer is a health problem in many Countries worldwide. Understanding the essential function of androgens in the prostate physiology led to the development of hormonal blockade as a therapeutic option in advanced disease, with limited response with time and development of resistance. In this stage, where castration resistant prostate cancer (CRPC) is defined, it is associated with poor prognosis because survival varies between 18 and 24 months. Even with castration levels, tumors are dependent on the functional androgen receptor (AR). In this paper, we analyze pretreatment clinical parameters such as prognostic or progression-predictive biomarkers, castration resistance mechanisms, the development of new technologies for the use of the so called liquid biopsies from biological ayufluids and the identification of circulating tumor cells as CRPC response and progression biomarkers. Currently ongoing clinical trials are partially oriented to the search of new prognostic and predictive biomarkers, that will enable to open up precision medicine and so to improve oncological patient's quality of life with it.

We review the role of immunotherapy in castration resistant prostate cancer. Two immunotherapeutic strategies have been applied, isolated or in combination, either with each other or with other agents with demonstrated efficacy in this scenario that would play a role as immunomodulators: vaccines or monoclonal antibodies aimed to block immune response checkpoint inhibitors. Although CRPC presents, a priori, characteristics suggesting that immunotherapy may play a relevant role as a therapeutic strategy, its clinical application has demonstrated a limited and heterogeneous activity, in terms of proportion of responders and response intensity. Generally, the objective response rate is very low, although, in patients who have response it is possible to detect a clear, long-lasting benefit. Only the autologous vaccine Sipuleucel T has demonstrated an overall survival increase in patients with good prognosis criteria. In these treatments, it is characteristic that no progression free survival increase is visible due to its action mechanism. PSA evolution may not be considered a surrogate variable of radiological response or clinical benefit in this environment either. It is necessary to identify what patient's or tumor's characteristics are able to maximize the response. An important limitation is the absence of response predictive biomarkers that serve for patient preselection. As a general rule, the best responses with isolated immunotherapeutic treatments have been observed in patients with low tumor load, which may suggest that their optimal application could be in earlier phases of the disease (high risk localized, biochemical failure, etc) Combination strategy, without doubt the one with best future, is based on additional treatments increasing cell lysis with the subsequent antigen exposure and/ or producing an immunomodulatory effect that can surmount tumor induced immunologic tolerance. The results obtained suggest that immunotherapy may be more effective in combined therapy with other active therapies (abiraterone, enzalutamide, Radium 223, docetaxel) in a fight to achieve disease chronification.

Objective: To know the level of confidence of fifth year medical students in order to perform maneuvers in bladder catheterization and rectal examination before and after training with simulators. To be able to assess student satisfaction regarding the use of the simulation as a learning method., Material and Methods: The study was conducted in the Simulation Center of the Faculty of Medicine. A total of 173 students who completed a practical workshop on the subject of Urology participated. The students were asked to answer anonymous questionnaires on their level of confidence in performing a bladder catheterization and rectal examination before and after the workshop as well as their satisfaction in using the simulation as a training tool. The workshops were organized using groups of 10 students. A teacher or a resident in that area of expertise supervised each student individually, resolving their doubts and teaching them the proper technique., Results: All the evaluations made on the different abilities were significantly higher after training (P<.001). Significant differences were found in the confidence level between men and women before the training regarding male urethral catheterization maneuvers and recognition of normal or pathological prostate, The confidence level was lower in women (P<.05). These differences disappeared after training. The level of overall satisfaction with the workshop was high, going from 4.47 ± 0.9 to a maximum score of 5., Conclusions: Simulation is a training method that helps improve the confidence of the medical student in performing a bladder catheterization and digital rectal examination., (Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.)

Renal cell adenocarcinoma requires different therapeutic pathways because it is one of the most therapy-resistant tumors, on the other hand it is biologically one of the most attractive tumors. Its pathological classification has a genetic base. There is an anomaly of the Von Hippel Lindau gene in 80% of adenocarcinomas, being this fact determinant to know the biological characteristics of tumor initiation and development, as well as the identification of factors susceptible to be used as therapeutic targets. Since 2005 a group of molecules have been used in the treatment of metastatic adenocarcinomas and, even though therapeutic results are significant but not clinically relevant yet, we are sure they are a key way for more efficient future developments. The present study tries to make a tour on the research of the biological anomalies in renal adenocarcinoma with special emphasis in the Von HippelLindau gene.

Objectives: The aim of this study was to evaluate the influence of retransplantation in graft and recipient survival., Methods: We carried out a retrospective study in 419 renal transplants and studied the influence of retransplantation in graft and patient survival. A homogeneity study was performed between the two groups with a Student`s T and a chi-square tests. Graft survival analysis was performed with Kaplan-Meyer and log rank tests., Results: Of 419 transplants, 370 (88.3%) were first transplantations, 45 (10.7%) second transplantations and 4(1%) third ones. Mean follow-up of the whole group was 72.5 months (±54.1 SD). There were no differences in follow-up between groups (Mean Follow-up 73.1 months ±54.4 SD in first transplantations vs. 61.6 months ±51.2 SD in repeat transplantation. p >0.05). The actuarial graft survival showed no differences between patients with first transplantation and those with a repeat one. [3 and 5 year SV of 89% (95% CI: 87-91%) and 84%(95% CI: 82-86%) Vs 88% (95% CI; 83-93%) and 85% (95% CI:i; 80-90%) respectively]. After adjusting for all the heterogeneity variables we still did not find differences on graft survival. The actuarial recipient survival showed no differences between patients with first transplantation and those with a repeat one. [3 and 5 year SV of 98% and 96% Vs.97%]., Conclusions: There are no differences of graft and recipient survival between patients with a first transplantation and those with a repeat one.

Objective: Renal malformations are rare entities and rarely have clinical consequences. Crossed renal ectopia has an incidence of 1/2.000 autopsies. The association with aortic aneurysm is even more exceptional., Methods: We present our case and perform a bibliographic review., Results: To date and in our knowledge, seven cases of crossed renal ectopia associated with aortic aneurysm were described on the literature. This malformation makes the treatment of the aneurysm more complex. The possibility of renal function decrease caused by injuries to the renal arteries during the surgical procedure is always present. Because of this risk of injury of the kidney during surgery preoperative evaluation of the vascularization must include image technologies as the MRI, CT-angiography or conventional arteriography. During the aortic intervention vascular conservation must be performed and it is necessary to minimize the time of renal ischemia., Conclusions: The association of crossed renal ectopia and aortic aneurysm is a rare event. The surgical intervention of the aorta does not have to necessarily originate a loss of renal function. Anyway the worsening of the renal clearance must be foreseen.

Introduction: In 2007 in Spain 43% of donors were older than 60 years. This produces a worse graft quality and probably a worse survival., Objective: Our objective is to analyze the influence of donor age on graft survival., Material and Methods: We analyze retrospectively 216 renal consecutive transplants realized between 2000 and 2008. A univaried and multivaried study (Cox regression) was performed and Kaplan-Meyer test with log rank for graft survival., Results: Follow-up mean of 40 months (+/-33,4 SD). The univaried analysis of graft survival showed that donor age had a significative influence on graft survival. (OR=1,03; 95% CI 1,01-1,05) (p: 0,009). Studying the relation between donor and recipient age we find an inverse correlation (Pearson's Correlation: 0,55. p<0,0001), but there are significative differences after the adjustment for recipient age. (OR: 1,02; 95% CI 1,01-1,04) (p: 0,04). Optimal cut-point value determined by the ROC analysis was 60 years. The graft survival of donors over 60 years is 79% (95% CI; 74-84%) and 71% (95% CI; 65-77%) at 3 and 5 years in contrast with 94% (95% CI; 94-96%) and 90% (95% CI; 88-92 in donors under 60. (p: 0,002). The multivaried study of the influential factors on graft survival reveals that donor age dichotomized in older or younger than 60, the presence of a surgical immediate reintervention and a delayed graft function were independent influence factors., Conclusions: Donor age over 60 years has a negative and independent prognostic influence on graft survival.

Objectives: To analyze surgical complications in kidney transplantation and their influence on graft survival., Materials and Methods: A retrospective analysis was made of the early and late surgical complications occurring in 216 consecutive kidney transplants performed at our institution and their influence on graft survival., Results: At least one surgical complication occurred in 82 (38%) of the 216 transplantations, and 68 (31%) required some type of repeat surgery, 23 in the early postoperative period and 45 more than 3 months after surgery. Mean follow-up was 48 months (SD +/-33.4), and median follow-up 48 months (range, 0-166 months). No recipient or donor factors predisposing to surgical complications were found. Graft survival was significantly shorter in patients with surgical complications [3- and 5-year survival rates of 86% (95% CI 83-89) and 78% (95% CI 73-82) as compared to 92% (95% CI 90-94) and 88% (95% CI 85-91), p=0.004]. Early repeat surgery, venous thrombosis, and wound infection were among the complications having an independent influence on graft survival. A multivariate analysis of graft survival in the whole group showed early repeat surgery to be a factor with an independent prognostic value (OR: 4.7; 95% CI 2.2-10, p<0.0001). Delayed function and donor age older than 60 years were the other independent influential factors. CONCLUSION Surgical complications have an influence on graft survival. The need for early repeat surgery, delayed function, and donor age older than 60 years are independent predictors of graft survival.

Objective: We present our 20 years experience treating patients with vena cava extension in whom an extracorporeal circulation, hypothermia, cardio circulatory arrest (ECC-H-CCA) in order to perform, together with a tumoral resection, a thrombus resection., Material and Methods: From 1985 to 2005 a total of 28 retroperitoneal tumor were treated: 25 renal cancers, a Wilms tumor, a paratesticular rabdomiosarcoma, and a pheocromocitoma. All of them had an extension by means of thrombus above the suprahepatics veins. All of them were treated by means of ECC-H-CCA for thrombus extraction. A descriptive study of the serie is performed as well as a Kaplan Meyer survival study., Results: Surgical complications were present within 10 patients (35%), with a surgical mortality of two patients (7%): one intra-operatively because a massive embolism of the lungs and the other because of a lung embolism on the 4th post-operative day. Global actuarial survival was 29.1+/-10% at three years and 17.5+/-8% at five years. Analyzing only who do not have metastatic lesions, nor lymph nodes at diagnosis their three year survival was 50.9+/-16.3% and 32.2+/-16% at five years. Mean while those who have any metastatic lesion at diagnosis their three and five years survival was 20.8+/-12% and 10.4+/-9% respectively., Conclusions: The employ of surgical techniques with ECC-H-CCA with in oncological pathology associated with vena cava thrombus is justified and its employment does not worsen the survival; it is indicated because its results, allowing a complete tumoral resection in a safe and reproducible fashion.

Objective: The purpose of this study was to evaluate results and complications of TVT in a large series from different hospital centers in Spain., Method: We retrospectively studied the results of TVT placement from 6 centers with 272 consecutive patients (median follow-up was 636 days). All types of stress urinary incontinence with a surgical indication were included and no previous conditions were established regarding the indication. No protocol was used for either the intervention or postoperative support measures. Data collection was protocolized and carried out using a common questionnaire that was completed by an urologist at each center from 3 to 6 months after the intervention and then annually. All patients who underwent intervention were asked about their satisfaction with the outcome. Multivariate studies were made to identify the factors that influenced the recovery of continence and the occurrence of complications., Results: 92.1% of patients were continent and 2.4% have not shown any improvement. 91.6% of the patients claimed to be satisfied whereas only 2.7% were dissatisfied. After four years only 2.8% of patients showed mild incontinence with time and 0.4% had moderate incontinence. Only previous surgery for incontinence was found to be significantly unfavorable factor for achieving postoperative continence., Conclusion: We have reproduced a scenario closer to daily clinical reality than the results of series from a single institution or analyses using stricter selection criteria. This multicenter study verifies the viability and reproducibility of TVT with minimal complications in centers where patients are not selected and where not all urologists are specialized in urinary incontinence.

Penoscrotal lymphedema is a rare disease in the developed countries, although it is relatively frequent in tropical countries. The most common cause is filariasis, although in our practice usually is associate to neoplasic and inflammatory processes, surgery, radiotherapy, hidroelectrolitic disbalances and idiopathic. We present a 22 years old patient with penoscrotal lymphedema due to hidradenitis suppurativa. After unsuccessful medical treatment, was performed a total excision of the penile skin and subcutaneous tissue to Buck's fascia. Split thickness skin grafts were used to cover the defect. Even medical management of penoscrotal lymphedema is not effective for most patients, surgery is a safe and effective procedure that gives excellent functional and cosmetic results.

Objective: To evaluate the clinical and pathological characteristics of cystic renal tumors in our center., Material and Methods: A retrospective review of 239 nephrectomies is performed comparing the clinical and pathological variables of cystic tumors with those of solid renal tumors. Survival outcomes are analyzed in both groups., Results: Our experience shows that cystic renal tumors behave like solid renal tumors, with no differences in survival shown. The variables studied show statistically significant differences in histological grade and number of tumors, with cystic tumors having a lower histological grade and being more often multiple in number., Conclusions: The behavior of cystic renal tumors is no different than that of solid renal tumors.

Several classes of drugs have been investigated for their efficacy in treating overactive bladder syndrome (OAB) and stress urinary incontinence (SUI). Surgery and behavioral therapies are currently the mainstay of treating SUI. However, results are also being made available about a new oral medication, Duloxetine, which appears to be clinically safe and effective for the treatment of SUI. On the other hand, a new muscarinic receptor antagonist, Solifenacin, has been shown in clinical trials to be clinically effective, safe and well tolerated for treating OAB.

The T.V.T. procedure has become a technique for Urinary incontinence and its different presentations. Many trials have reported the efficacy of this technique for different situations, as well as its results and complications. We review the literature and analyze the results and complications, comparing this technique with other such procedures.

Objective: To study the clinical and pathological characteristics of incidental renal tumors treated in our center., Material and Methods: A retrospective review is conducted of 318 nephrectomies comparing the clinico-pathological variables of renal tumors diagnosed incidentally with those of symptomatic renal tumors. The factors influencing disease-free survival are analyzed in both groups., Results: In our experience, although incidental renal tumors presented better survival than symptomatic ones owing to their better pathological state and tumor grade, incidental diagnosis was not an independent influencing factor in the multivariate study. Only when patients were studied who did not present metastases on diagnosis did incidental diagnosis become an influencing factor very close to statistical significance., Conclusions: Incidental diagnosis is not an independent prognostic factor.

Metastases in the kidney are rare, evenmore if primary source is thyroid. We report the tenth case of metastases in the kidney from thyroid, and it is the first to be follicular type and absolutely asymptom. Sonography and computerized tomography with suspicion of renal tumour are showed in a asymtom female 75 years old. Left partial nephrectomy was perfomed, initially it has been pathologically diagnosed as renal clear cells tumour, however the definitive pathologic report showed follicular tumour of thyroid. Local and systemic stage was discovered with complementary techniques. Sources of metastases in kidney and diagnoses techniques are discussed.

Unlabelled: The aim of this study was to detect mutations in the human androgen receptor gene in radical prostatectomy specimens., Material and Methods: The genomic sequence was realized in 67 radical prostatectomy specimens. The mean age was 64 years old. The PSA median was 15 ng/ml. TNM 1997: 34.3% were T1 and 65.7% T2. Genomic sequence: 1. Radical prostatectomy specimens desparaffitation. 2. Extraction of the DNA 3. DNA amplification. 4. Automatic genome sequence. 5. Comparison with Gene-Bank., Results: 16.7% of the specimens were mutated. The most frequent mutation was the punctual mutation. The exon most frequent mutated was exon 1.

Primary tumors of extragonadal origin are rare, with fewer than 1000 cases described in the literature. Although the exact incidence of EGTs is unknown, clinical data suggest that roughly 3% to 5% of all germ cell tumors. We expose a case report of EGT with unusually clinic presentation. We present our diagnostic and therapeutic experience in this injuries.

Prostate carcinoma is diagnosed in earlier phases of its evolution, but this carcinoma may have an unpredictible evolution. Radical treatment (surgery and radiotherapy) is the best treatment in clinically localized tumors. The biochemical failure over 5 years from the surgery is 20-50% of the patients; the biochemical failure over 10 years from the surgery is less frequent because of prognostic factors from the biologic nature of the tumor. We report a case with biochemical and clinical failure over 10 years from the surgery.

Objectives: To identify independent predictors of progression and global survival in patients affected by pT3 renal cell carcinoma. To make risk groups by risk factors., Material and Methods: We evaluated 117 patients with pT3 renal cell carcinoma. 88 was M0 and 29 M1. Most frequent clinical feature: asintomatic patients. 80 males (69%) and 37 females (31%). Mean age 59 (24-82). Median follow up 34 months (mean 44 +/- 39 months)., Results: Pathological stage (TNM 1997) was pT3a in 52 patients (43.6%), pT3b 63 patients (53.6%) and pT3c 2 patients., Histology: clear cell carcinoma 106 patients (90.6%), papillary 5 patients (4.3%) an dchromophobe 4 patients (3.4%). Nuclear grading according Fuhrman's classification: G1 13 patients, G2 45 patients, G3 32 and G4 12 patients. Size > 4 cm (p = 0.005/p = 0.0019), grade 3-4 (p = 0.006/p = 0.0007), N+ (p = 0.034/p = 0.009) and M+ (p = 0.035/p = 0.042) were independent prognosis factors for progression and global survival of the pT3 renal cell carcinoma. Patients M0 with 0 or 1 risk factor have better global survival tanh patients M0 with 3 or 4 risk factors and patients M1., Conclusions: Size, grade, N+ and M+ were independent prognosis factors for progression and global survival of the pT3 renal cell carcinoma. Tera are no differencies in global survival between patients M0 with 2 or 3 risk factors and patients M1.

The standard therapy for renal carcinoma is radical surgery. When dealing with single, under 4 cm tumors and in the case of renal tumors in single-kidney patients, the choice therapy is nephrectomy or partial nephrectomy. Response rates in metastatic renal carcinoma using the various immune therapy approaches available range from 15 to 35%, responses being short-lasting.

Significant conceptual changes have taken place in renal tumoral diseases over the last few years. As a result of the authors' broad institutional experience, this overall revision describes the most up-to-date clinical and diagnostic aspects of this condition. Emphasis is made on molecular staging and two variables that guide the prognosis of the disease, a decisive feature to establish treatment and to contribute to change current survival rates.

Objectives: To determinate whether increased expression of the p53 and Ki67 and the of the tumour suppressor gene retinoblastoma (prot Rb), in an immunohistochemistry study, were associated with relapse in invasive bladder cancer., Materials and Methods: 47 patients with invasive bladder cancer. 42 men and 5 women. Mean age 63 years old. Relapse in 19 patients (40%). Mean time until recurrence 8.5 months. p53 and Ki67 were study in 47 patients and prot Rb in 40 patients., Results: p53: Mean expression 41%. There were significant differences in the increased expression of p53 between patients with and without relapse (p = 0.03). A statistically significant association was then observed between patients with p53 > 20% (vs p53 < 20%) and adverse outcome of the disease (p = 0.04). Ki67 and prot Rb: There were no significant differences in relapse and progression free survival between Ki67 > 40% (vs Ki67 < 40%) and prot Rb < 10% (vs prot Rb > 10%). p53 expression showed a statistically significant correlation with Ki67 and prot Rb., Conclusion: p53 is a good prognostic marker for the relapse and progression free survival in invasive bladder cancer.

Purpose: Prostate biopsy is the diagnostic method to detect prostate carcinoma. We try to identify the optimal PSA cut-off, biopsy indication and the clinico-pathological characteristics in order to differentiate those patients with negative biopsy in which we should repeat the proceeding., Method: We study 344 biopsies in 292 patients for 16 months. An univariate and multivariate study to identify the influent factors in the existence of prostate cancer in the first biopsy and in the patients with a second one was taken place., Results: Patients in the first biopsy Univariate study: Out of these variables (PSA, PSA ratio, digital rectal examination and prostate volume) just the PSA has statistical significance. Multivariate study: Only the the PSA is an indepent influence factor. Receiving Operated Curve: The optimal cut-off is 10.5 ng/ml. Patients with a second biopsy Univariate study: None of the variables is related with the existence of prostate cancer. Groups comparison: A comparison between the patients in the first biopsy and the patients with a second biopsy is performance with no statistical differences in the variables already mentioned., Conclusion: The patient with a PSA greater than 4 ng/ml should be perform a prostate biopsy, mostly if his PSA is over 10 ng/ml. In our experience we do not related the need of a second biopsy with any factor in particular, therefore in our opinion and because of the high rate of negative false, all of the patients should be controlled and undergo a second biopsy if any change in PSA or clinics modification takes place.

Objectives: To study the survival in patients with prostate adenocarcinoma, lymph nodes involvement in the intraoperative pathological examination, evaluating both radical surgery and early ablation as treatment. Identification of clinical factors that can predict node involvement., Method: 20 patients who underwent radical prostatectomy between 1988-1998 were included in the study. All patients clinically diagnosed with T1-2N0Mx prostate adenocarcinoma (T.N.M. 1992), single metastatic node involvement in the pathological study and early sub-albuginea orchidectomy. This group was compared to a 200-patient control group also with T1-2N0Mx prostate adenocarcinoma but with no pathologic nodular involvement. Statistical study: contingency 2Xb tables (Pearson's chi 2 or Fisher's exact test) to compare qualitative variables; Student's t test for means comparison; Kaplan-Meier for actuarial survival calculations and comparison of Log-rank survival curves. For the study of clinical variants with influence in node involvement a logistic regression model was used., Results: Mean age was 63 +/- 0.8 years. Median follow up 56 months. Mean PSA 33 +/- 4.4 ng/mL and 55% had Gleason 5-7. 16 patients were stage pT3. Specific 5-year survival was 90 +/- 8% and biochemical progression free survival 63 +/- 12%. Clinical variables with statistical significance for node involvement are: pre-surgical PSA greater than 20 ng/mL (RR = 4.6), and Gleason higher than 4 (RR = 3). The remaining variables showed no statistical significance., Conclusions: Gleason and PSA are the only clinical values that predict node involvement. The procedure performed obtains good results and a survival comparable to that of the control group.

Objectives: To assess the efficacy of surgery in pT3c patients; to discern whether this is an independent influential factor for survival and clinical factor for diagnostic prediction., Material and Methods: Forty-five pT3c (TNM 1982) patients from a cohort of 220 subjects with T1-T2 prostate cancer who underwent radical prostatectomy. Mean and median follow-up: 42 and 36 months, respectively., Results: pT3 stage accounts for 20% (45/220) patients. They display a significantly higher mean PSA (25 +/- 2 ng/ml) (0.001), worse Gleason (0.0002) and clinical stage (0.0003), greater margins involvement (0.0007), and biochemical (0.02), local (0.05) and metastatic (0.001) progression. Independent influential factors are: PSA > 20 ng/ml; T2bc and Gleason 7-10. From these values patients can be divided into 3 risk groups: a) Group I (0-1 unfavourable variables): risk of seminal vesicle involvement 7%; Group II (2 unfavourable variables): risk 47%; Group III (3 unfavourable variables): risk 61%. Progression-free survival: significantly lower than patients with pT2 (58 +/- 8% vs 66 +/- 6% at 5 years) (0.002), but similar to those with pT3ab (0.91). Seminal vesicle involvement is not an independent influential factor (Cox's multivariate study). Influential factors are PSA, Gleason and clinical stage., Conclusions: pT3c tumours are not an independently influential group in progression-free survival. Progression-free survival is lower than pT2 but similar to pT3ab. Their poor prognosis is dependent on association to negatively influential clinico-pathological factors.

Objective: To assess the influence of neo-adjuvant hormone therapy on the pathologic stage, margins and disease-free survival in patients with T1-T2 prostate cancer after radical prostatectomy., Material and Methods: Forty-two non-randomised, T1-T2 patients who underwent complete neo-adjuvant blockade and radical prostatectomy between 1988-1998 were included in the study. This group is part of a larger cohort of 220 T1-T2 patients treated with radical surgery. The group is compared to: a) the remaining patients (178) (Group I) and b) a selected group (54 patients) of consistent characteristics relative to clinical variables (Group II). Mean follow-up: 35 months; median: 32 months., Results: Compared to Group I patients with neo-adjuvant therapy show worse Gleason (p: 0.01), worse clinical stage (p: 0.02), higher rate of patients with high clinical risk (p: 0.03), and higher PSA (though not statistically different). No differences were seen relative to pathological status or margins. Compared to Group II (54 patients) no differences are found in clinical or pathological variables. Groups are comparable in terms of progression-free survival., Conclusions: Neo-adjuvant hormone therapy in high clinical risk, T1-T2 patients does not involve improvement in pathological stage, margins or progression-free survival.

Objectives: To study patients with ureteropelvic junction obstruction treated in our department and a retrospective study of this pathology, focus our attention in the diagnosis and treatment., Material and Methods: 62 patients from 7 weeks to 68 years old (mean 29 +/- 1.9). Half of the patients were men and the other half women. In 30 patients the UPJ obstruction was on the right side and 32 patients was on the left side., Results: The most frequent symptom was the flank pain (46.8%). To confirm the diagnosis, we had IVU in the 61.3% of the patients and ultrasound in the 38.7%. The treatment was the Anderson-Hynes pyeloplasty in the 96.8% of the patients. In 33 patients we used a ureteral catheter. The overall success rate was 90.3%. The 29% of the patients presented postoperative complications., Conclusions: Open pyeloplasty is the gold standard treatment of the UPJ obstruction in selected cases, mainly in children.

Objectives: Analysis in T1-T2 prostate cancer of the following: a) Whether there is a relationship between Ki67 and p53 over-expression, and clinico-pathological variables. b) Whether that expression influences on progression free survival., Material and Methods: The study included 68 patients diagnosed with T1-T2 prostate cancer undergoing radical prostatectomy and immunohistochemical testing of Ki67 and p53 in the prostatectomy specimen, indicating in each case the percentage of stained cells. The study was carried out by: a) Comparison of means between percentage groups of stained cells. b) Grouping patients according to expression percentage. In Ki67, a comparison is made between those expressing 0-5% vs > 5%. In p53, those expressing (0%) vs > 1%. Mean follow-up: 20 months; median: 16 months., Results: Mean expression of Ki67 is 7.2% (57% cases > 5%). 60% do not over-express p53; mean 3.65; only 15% is higher than 5%. There is a correlation between Ki67 and p53 (p: 0.002), but not to PSA. Ki67 expression is related with a poorer pathological stage (p: 0.07) and greater biochemical progression (p: 0.07), and it has a significant influence on progression free survival in both the univariate (at three years 76% vs 48%; p: 0.04) and the multivariate studies (RR: 5.7; p: 0.005). Over-expression of p53 is not related to any clinico-pathological variable, and does not influence progression free survival.

Objective: To describe a case of epithelial cell paratesticular carcinoma of the epididymis and briefly review the literature on this tumor type., Methods/results: A 69-year-old male consulted for a testicular mass and intrascrotal pain, together with irritative bladder symptoms. The patient underwent orchidectomy, but consulted again shortly thereafter for persistent irritative bladder symptoms. A TUR biopsy of the bladder wall demonstrated undifferentiated carcinoma arising from the epididymis. The patient did not respond to chemotherapy. He developed systemic metastasis and died 4 months after the diagnosis., Conclusions: Carcinoma of the epididymis is a rare malignant paratesticular tumor arising from the epithelial cells with a very poor prognosis. Its clinical features are unspecific and this tumor type should be taken into account when making differential diagnosis from intrascrotal masses arsing from other causes. Due to the rarity of this disease, it has not been possible to identify treatments that might achieve better results.

Objectives: Margins involvement in T1-T2 patients undergoing radical prostatectomy is a negative prognostic factor. We aimed to: a) Study the clinical and pathological features of patients with surgical margins involvement; b) Elucidate the influence of margins involvement on the progression-free survival., Material and Method: The study included the group with "positive margins" out of a series of 160 patients with localised prostate adenocarcinoma who underwent radical prostatectomy at the Clínica Universitaria de Navarra between 1988-1997. statistics used: Fisher's or Pearson's test for qualitative variables. Kaplan-Meyer, Log-rank and Cox's multivariate tests for the survival study., Results: The group accounts for 28% (45/158) of all patients undergoing radical prostatectomy. Mean PSA (22 +/- 14 ng/ml) is similar to the remaining group although there is greater significant rates of PSA > 15 ng/ml (p: 0.006), worse Gleason (p: 0.01), higher proportion of T2bc (p: 0.003) and node involvement (0.001). Progression-free survival (BPFS) is significantly lower in this group (32 +/- 12% vs 61 +/- 6% at 5 years). Margins are the single factor with higher influence (RR:5) in the multivariate study. Influence is clear in patients with Gleason < 5 (0% vs 87%) and PSA < 30 ng/ml (33 +/- 14 vs 70 +/- 7%), but has no influence on BPFS of patients with PSA > 30 ng/ml or Gleason 5-10., Conclusions: Positive margins in patients undergoing radical prostatectomy is associated to higher PSA, worse Gleason and higher stage. They are the most significant independent risk factor (except for PSA > 30 ng/ml) for biochemical progression-free survival as evidenced in the multivariate study, although it is likely this influence is diluted in patients with PSA > 30 ng/ml and/or Gleason 5-10.

Material and Methods: Study of the pathoanatomical features and influential factors on survival of 59 patients diagnosed with a tumour of the upper tract urothelium managed with radical surgery., Results: Mean age 65 years, 83% male, and tumour located in the renal pelvis in 64% cases. 54% was pT1-2, 73% G1-2. 10% had node involvement and 15% metastasis. 44% presented concomitant vesical tumour. No surgery-related deaths were reported. 60% was still alive at study completion. Five-year overall actuarial survival was 60 +/- 7%. Mean survival was 134 months, and median survival 156(101-168 months. 95% CI). Gender, site, morphology, type, concomitant vesical tumour, nodes number and involvement do not significantly influence survival. Only tumour differentiation (p = 0.006) and pathological stage (p = 0.005) are significant in the univariate analysis. The multivariate study showed that pathological stage is the only factor that influences survival., Conclusions: The most influential independent factor on survival of patients with upper tract endothelium tumour is the pathological stage. Grade is influential in the univariate analysis, and is likely to be a subsidiary factor. Due to the small number of cases, it can not be ruled out that node involvement and type of tumour have an influence on survival.

Material and Methods: Study on the efficacy of stage diagnosis, how to support it based on clinical objective data and description of a prognostic model. Analysis of 160 patients diagnosed with localized prostate adenocarcinoma undergoing radical prostatectomy in the Clínica Universitaria de Navarra between 1988-1997. The statistical study used Fisher's or Pearson's tests for the comparison of qualitative variables. A logistic regression multivariate analysis was run to avoid confounding factors in the pathological stage., Results: 85/160 (53%) were correctly staged. Incorrect staging occurred in patients with higher clinical stage (T1-T2a: 25%; T2bc: 65%). The univariate study shows that the pathological stage is significantly correlated to: a) serum PSA levels (15 ng/mL in P2 vr. 25 ng/mL in P3-4), the most suitable cutoff value being 15 ng/mL. b) digital rectal examination and Gleason. Negatively influencing factors in the multivariate study were: PSA greater than 15 ng/mL, Gleason greater than 5 and a T2bc clinical stage. Risk groups: 4 risk groups are established based on the above factors (inclusion in group 1 involves an 8% risk of having P3, 30% in group 2, 56% in group 3 and 84% in group 4)., Conclusions: The clinical factors with influence in the pathological stage are PSA, Gleason and clinical stage. The reliability of the risk groups established based on these factors is remarkable.

Material and Method: Study of biochemical progression (PSA > 0.5 ng/ml) and biochemical progression-free survival in 160 patients diagnosed with clinically localized prostate adenocarcinoma who underwent radical prostatectomy at the University Clinic in Navarra between 1988-1997., Results: At the end of the study, 120 patients (75%) are alive and free of progression, 33 (20%) are alive and in progression, 3 (1.9%) died of cancer, and 4 (2.5%) died for other causes. Biochemical progression occurred in 43/160 (27%) patients. Progression is related to previous PSA, both in absolute terms and divided into greater or smaller than 15 ng/ml; to Gleason grade greater or smaller than 7 or divided into 2-4, 5-7, 8-10; to pathological stage and to urethro-vesical junction stenosis. Biochemical progression-free survival (BPFS) in the univariate study is related to PSA (the ideal prognostic cut-off value being 15 ng/ml); to Gleason, specially when divided into 2-4, 5-7, 8-10; to the pathological stage and to margins. The multivariate study evidences that the single most influential factors are PSA (divided as greater or smaller than 15 ng/ml), Gleason grade (divided into: 2-4, 5-7, 8-10) and margins involvement. There are 3 highly reliable risk groups based on PSA, Gleason and clinical stage. When these are introduced as variables in the multivariate study, they appear as the strongest predictive variables., Conclusions: The influential factors on progression-free survival are PSA (15 ng/ml being the best prognostic cut-off value), Gleason grade (divided into 2-4, 5-7, 8-10) and margins' positivity, which are the single most significant pathological factor ahead of clinical stage. Serum PSA, clinical stage and Gleason grade allow to define three reliable risk groups.

Study of 165 patients with prostate adenocarcinoma who underwent radical prostatectomy using a retropubic approach. Mean PSA is 19 ng/ml, mean age 63 years and median follow-up 26 months. 22 patients (13.2%) reported complications during the first month post-surgery, primarily urinary fistula of more than 5 days long in 5 patients and rectal injury in 3.49 patients (29%) reported complications after the first month, mainly urinary incontinence in 26 cases and stenosis of the urethrovesical juncture in 15. The group with early complications showed no significant differences compared to those who had none, neither in PSA (p = 0.3) or a worse pathological stage (p = 0.1), and no evidence is shown in terms of biochemical progression or in disease free progression (p = 1). Patients with urethrovesical juncture stenosis have higher mean PSA (p = 0.01), greater biochemical progression (p = 0.006), worse Gleason (p = 0.03 = and worse progression free survival (p = 0.01). Patients with stress incontinence showed no differences compared to the other groups relative to the studied factors.

Contribution of one case of right paratesticular rhabdomyosarcoma in a 3-year and 4-month old male patient. Following radical orchiectomy and clinical staging, grading is IRS Group I (fully resected localized disease). Subsequently, the patient received 7 polychemotherapy courses and was found to be asymptomatic 4 years after treatment.

Retrospective study of 107 patients diagnosed with infiltrant tumour of the bladder in stage T3-T4 N0-N1, treated with radical surgery. Eighty-four (84) received neoadjuvant therapy with radio- and/or chemotherapy. The neoadjuvant treatment was seen to provide significantly better survival, but the specific type of neoadjuvant treatment appears to have no influence. The multivariate study evidenced that the two most influential variables for survival are the complementary treatment and the clinical stage.

A prospective study which analyzes the presence of mutations in the suppressor oncogene p53 through automated genome sequentiation in 75 specimens of transitional cell carcinoma. The presence of mutations correlated to the pathological stage and cellular grade. Also, both the different types of mutations detected and the diversity of their location indicate the heterogeneity of bladder transitional cells carcinoma. The automated genome sequentiation method allows to detect both the type of mutation and the exact location. The detection of suppressor oncogene p53 mutations allows to identify those patients who may be at higher risk of disease progression and therefore those who should undergo a more intense follow-up.

Presentation of 11 cases of retroperitoneal sarcoma. Mean time from the beginning of symptoms to diagnosis is 6 months. The primary complementary study is CT. Surgery was performed in all cases, using complete resection in 6 cases, and partial resection in 5. Ten patients relapsed. 9 of which were treated with surgical rescue, in one or more occasions; chemotherapy was added in 6 cases and radiotherapy in 7. Survival at five years is 68%, with a mean follow-up of 66 months.

Presentation of 7 case reports of pheochromocytome, diagnosed and treated in our Centre between 1981 and 1995. Clinically all patients had hypertension. Three presented the triple condition of hypertension, pulsatile headache and palpitations. The most useful analytical studies were urine vainillylmandelic acid (VMA) and catecholamines. The main radiologic method was the scanner (CT). Pre-surgical preparation was with alpha-blockers in 5 patients, adding beta-blockers in 3. Treatment was surgical in all cases, and the approach was selected based on the tumour's size and location. One patient with severe rheumatic heart disease died on day 3 post-surgery. Mean follow-up is 19 months, and only one patient requires anti-hypertensive medication following surgery.

Between January 1989 and October 1995, 104 prostatectomies were performed in patients with prostate carcinoma in our centre. Mean follow-up 22 months, range 3-84 months. Overall frequency of complications was 33%. No fatal complications were reported. Complications in the early post-operative occurred in 17 patients (16%); late complications in 18 patients (17%), the most frequent one was stenosis of urethrovesical by-pass. No case of total incontinence has been recorded. The rate of stress incontinence at 3 months was 36% and 15% at 9 months.